Identification of mycobacteria species by molecular methods.

In this study, mycobacteria, which were previously identified as Mycobacterium tuberculosis complex (MTC), and mycobacteria other than tuberculosis (MOTT) with cord factor and the p-nitro-alpha-acetyl-amino-beta-hydroxypropiophenone (NAP) test were reanalysed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis method in order to confirm the identification, and at the same time, species accepted as MOTT were identified. Although the results of the NAP test were obtained within 3-5 days, the PCR-RFLP results were obtained in 1 day. Ten species identified as MTC with the NAP test and cord factor were confirmed with the PCR-RFLP method. Fourteen species accepted as MOTT were identified as Mycobacterium species with the evaluation of the bands observed after the restriction of PCR product with the PCR-RFLP method. These were as follows: three species Mycobacterium intracellulare type I, two species Mycobacterium phlei, two species Mycobacterium kansasii, one species Mycobacterium fortuitum type I, one species Mycobacterium gordonae type I, one species Mycobacterium abscessus type I, one species Mycobacterium scrofulaceum, one species Mycobacterium szulgai type I, one species Mycobacterium avium type II, and one species Mycobacterium terrae. Hence, the results of both the cord factor and the NAP test were confirmed with the molecular method, and at the same time, mycobacteria species identification was made by determining the fastest, easiest, and the most accurate result-giving method. Because PCR-RFLP is a very rapid method that provides exact identification of mycobacteria species, it can be performed in routine procedures.

Assessment of cytokine levels and hs-CRP in bipolar I disorder before and after treatment.

We aimed to assess the relationship between cytokine levels and the severity of the manic period in medication free patients. 30 Medication free patients and 28 healthy subjects (HS) were recruited. Plasma levels of pro-inflammatory, anti-inflammatory, inflammatory cytokines, and hs-CRP levels were investigated upon hospital admission, after six weeks follow up in bipolar disease manic episode and the results were compared to HS. The severity of the manic episodes was assessed according to the Young mania rating scale. TNF-α, INF-γ, IL-6 and hs-CRP levels were significantly higher in patients with manic episode of bipolar I disorder before treatment than HS. After treatment the levels of TNF-α, INF-γ, IL-6 and hs-CRP were observed to be significantly decreased. There was no difference between the levels of anti-inflammatory cytokines in patients before or after treatment of bipolar disorder and HS. hs-CRP was observed to be the only parameter correlated with clinical response. The most significant outcome of this study is the correlation between clinical outcome and hs-CRP levels in treatment naive manic episode bipolar type I patients. hs-CRP is the most consistent indicator according to pro-inflammatory, inflammatory and anti-inflammatory cytokines, in predicting treatment outcomes.

The relation between the levels of osteoprotegerin and the degree of coronary artery disease in patients with acute coronary syndrome and stable angina pectoris.

BACKGROUND: Osteoprotegerin (OPG), an inhibitor of osteoclastogenesis, has recently been under the spotlight in studies regarding the pathophysiology of atherosclerosis. AIM: To evaluate the value of serum OPG in the diagnosis and severity in patients with stable angina pectoris (SA) and unstable angina pectoris/non ST elevation myocardial infarction. METHODS: This study involved 160 patients, SA (n = 65), acute coronary syndrome (NSTE-ACS; n = 65), and a control group (n = 30). Blood samples were collected in the first hour, after 24 hours and on the fifth day. The prevalence of coronary artery atherosclerotic lesions was determined using the Gensini scoring system. RESULTS: A statistically significant difference was observed in the first hour OPG levels between the control group and both the SA and NSTE-ACS group (p < 0.001). When the cut-off value was determined as 247.71 pg/mL, the sensitivity and specificity of the first hour OPG levels indicating coronary artery disease were 91.54% and 46.67%, respectively, while the positive predictive value was 88.1% and the negative predictive value was 56%. No correlations were observed between the first, 24th hour and the fifth day OPG levels and the Gensini scores. No relation was denoted between the OPG levels and number of diseased coronary arteries. CONCLUSIONS: In our study, serum OPG level seemed to be unrelated to the severity or the degree of coronary artery disease in patients with SA and unstable angina pectoris/non ST elevation myocardial infarction. OPG may only be accepted as an indicator of coronary atherosclerosis.

The role of serum cytokines in the pathogenesis of hepatic osteodystrophy in male cirrhotic patients.

Objective. In this study, we aimed to investigate the possible role of serum cytokines in the development of hepatic osteodystrophy. Matherial and Methods. 44 consecutive male cirrhotic patients (17 alcoholic, 20 hepatitis B, 7 hepatitis C), 15 age- and sex-matched chronic alcoholics without liver disease, and 17 age- and sex-matched healthy controls were included in the study during one year period. Bone mineral density was measured by dual X-ray absorptiometry in the lumbar vertebrate and femoral neck. Serum interleukin levels were measured by ELISA method. Results. Although osteopenia frequency between our cirrhotic patients was 20%, there was no difference in T-scores among the controls and other groups. Serum interleukin-1, interleukin-8, and tumor necrosis factor-alpha levels were not different between all groups. Serum interleukin-2 and interleukin-6 levels were higher in the cirrhotics than controls (P < 0.001). However, there were no significant difference between osteopenic and nonosteopenic cirrhotics. Conclusion. According to the results of the study in this small population of 44 male cirrhotic patients, frequency of hepatic osteopenia is small and serum interleukins 1, 2, 6, 8, and tumor necrosis factor-alpha may not play a role in the pathogenesis of hepatic osteodystrophy. Further studies in which large number of patients involved are necessary in this field.

[Hepatitis E virus epidemiology in adult population in Edirne province, Turkey]. / Edirne'de eriskinlerde hepatit e virus enfeksiyonu epidemiyolojisi.

Hepatitis E virus (HEV) clinical presentations range from asymptomatic infection to fulminant hepatitis which is frequently seen in pregnant women. Epidemics due to HEV mostly originate from contaminated water and the virus is transmitted by fecal oral way. Its frequency is closely related to the socioeconomical status of the community. The aim of this first community-based study performed in Edirne province (located at Trace region of Turkey) was to determine the seroprevalence of HEV and the risk factors in the city center. Five hundred eighty two people (273 men, 309 women) over age 15 years, representing the population of Edirne city center were included in the study. Anti-HEV IgG antibodies were investigated in the serum samples by ELISA method. Anti-HEV antibodies were detected in a total of 14 cases (11 women, 3 men) and HEV infection prevalence was found to be 2.4%. The mean age of seropositive people was 50.86 +/- 16.76 years while it was 40.7 +/- 16.9 years in seronegative people (p = 0.027). This result was attributed to the better water supply and sanitation conditions in Edirne province in comparison to other parts of Turkey and shift of HEV seropositivity in older ages. No statistically significant difference was detected between seropositive and seronegative cases in terms of socioeconomical conditions, both groups being in high socioeconomical level. The analysis of the risk factors revealed that the rate of people living in houses built with materials other than reinforced concrete (p = 0.044), dealing with stockbreeding (p = 0.046) and consuming fruits and vegetables without proper washing (p = 0.015) were significantly higher in the seropositive group. No statistically significant difference was detected for the other risk factors such as the number of household, presence of city water supply and sewage system in the house, location of the water closet outside house, lack of hand-washing habits, sharing utensils, consumption of raw vegetables, history of blood transfusion, surgery, dental intervention, jaundice, contact with a case of hepatitis, abortion/stillbirth and suspicious sexual contact. While the HEV seropositivity rate (2.4%) detected in Edirne was lower than the average of Turkey (6%), it was similar to the results reported from western part of the country. High rates of seropositivity among people with individual incompatibility to the hygiene rules denotes that personal hygiene is an important factor for prevention from HEV infection. High rate of seropositivity among people dealing with stockbreeding also suggests that there may be different ways of HEV transmission other than contaminated water in sporadic cases.

Community-based seroepidemiology of diphtheria and tetanus in Edirne, Turkey.

The aim of this study was to evaluate the seroprevalence and correlates of diphtheria and tetanus in Edirne, Turkey. Tetanus and diphtheria antitoxin levels were determined by enzyme-linked immunosorbent assay. Among 99 participants, a diphtheria antitoxin level of >or=0.1 IU/mL was found in 97 (98%), while 2 (2%) had antitoxin levels of 0.011-0.099 IU/mL. The geometric mean titres (GMTs) in men were statistically higher. Among 295 participants, a tetanus antitoxin level of >or=0.1 IU/mL was found in 291 (98.6%), while 4 (1.4%) had antitoxin levels of 0.011-0.099 IU/mL. Participants who had completed secondary school or higher education showed higher GMT values. Additionally, participants vaccinated within the previous 5 years had higher GMT values and the percentage of participants who had completed secondary school or higher education was higher among them. GMTs decrease with increasing age and increase as the poverty index increases. The average socioeconomic status index of the participants was high for both diphtheria and tetanus seroepidemiology. In this community-based study, antitoxin levels of diphtheria and tetanus were high. However, revaccination of adults with tetanus-diphtheria toxoids at every opportunity (military service, pregnancy, post-injury prophylaxis, etc.) together with a single booster every 10 years should be considered as an immunization policy.

[Investigation of tularemia seroprevalence in the rural area of Thrace region in Turkey]. / Trakya bölgesinin köylerinde tularemi seroprevalansinin arastirilmasi.

The first published tularemia epidemic in Turkey had been reported in 1936 from Luleburgaz (located in European part-Thrace region-of Turkey), and the second was in 1945 again in the same province. Following a long period of time without any tularemia report from Thrace region, in 2005 another epidemic occurred in a village of Edirne, another province located in the same region. Since there is presumptive evidence of circulation of the infectious agent, Francisella tularensis in Thrace region of Turkey, a large scale seroepidemiological study is needed. In this study, the presence of antibodies against F. tularensis in 1782 subjects, choosen by "thirty cluster" method, inhabiting in 90 different villages of Edirne, Kirklareli, and Tekirdag provinces in Thrace Region, were investigated. The subjects were included to the study on the basis of volunteering (74.3% were male; mean age: 46 years; age range: 6-92 years) and demographical characteristics and their possible risky behaviours were recorded in a questionnaire form. Antibodies specific for F. tularensis were screened by microagglutination test, and were found positive in five (0.3%) of the subjects between the titers of 1/20- 1/160. All of the seropositive subjects were adult males (ages between 22-74 years); three were living in the two villages of Kirklareli, while the others were from the villages of Tekirdag and Edirne. Rose Bengal test was also found positive in three of the seropositive subjects, and with the thought of a probable cross reaction they were taken into an advanced investigation for brucellosis. The risk evaluation revealed that male gender, being together with livestock and exposure to ticks were the major risk factors. Since the data of this study indicated that F. tularensis is in circulation in Thrace Region, the educational programmes for both the healthcare workers and inhabitants of this region should be attempted for the prevention of a possible epidemic.